During the Anterior Drawer Test for the ankle, which finding indicates an ATFL injury?

• A. Laxity with anterior translation of the heel
• B. Dorsiflexion weakness
• C. Posterior ankle tenderness
• D. Inversion-only pain without laxity

Answer: (A)

The test is about ATFL stability. The ATFL resists forward (anterior) movement of the talus relative to the tibia when the ankle is in plantarflexion. If the ATFL is injured, you’ll feel or see increased anterior translation of the talus (the heel moves forward more than normal) along with laxity during the ankle “draw.” That laxity is the hallmark of an ATFL tear.

Other findings don’t reflect this instability. Dorsiflexion weakness points to problems with muscles or nerves rather than ligamentous laxity of the ATFL. Posterior ankle tenderness suggests issues with posterior structures like the Achilles tendon or posterior impingement. Inversion-only pain without laxity suggests a milder sprain or injury to structures other than the ATFL without true anterior instability.